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Impairment of the central nervous system in demyelinating polyneuropathies: neurophysiological, clinical and neuroimagery aspects


Author: Vitalie Lisnic
Degree:doctor habilitat of medicine
Speciality: 14.00.13 - Neurology
Year:2006
Scientific consultant: Diomid Gherman (decedat)
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 26 September, 2006
Approved by NCAA on the 26 October, 2006

Abstract

Adobe PDF document4.89 Mb / in romanian

Thesis

CZU 8:616.833-002-0371.67

Adobe PDF document 11.92 Mb / in romanian
214 pages


Keywords

acute inflammatory demyelinating polyneuropathy, chronic inflammatory demyelinating polyneuropathy, hreditaty motor-sensory polyneuropathy type I, multiple sclerosis, alcohol axonal polyneuropathy, motor evoked potentials, central motor conduction time

Summary

The present study is based on the investigation of 25 patients with acute inflammatory demyelinating polyneuropathy (AIDP), 55 – with chronic inflammatory demyelinating polyneuropathy (CIDP), 30 - with hereditary motor-sensory polyneuropathy, type I (HMSP I), 30 – with multiple sclerosis (MS), 30 – with alcohol axonal polyneuropathy and 20 healthy volunteers. The goal of the research was to study the clinical, electrophysiological and neuroimagery interrelations of impairment of the central and peripheral nervous system (PNS) in diseases with pollard demyelinating manifestations: central and peripheral.

The research revealed the existence of a common demyelinating disorder with impairment of the myelin both of the central nervous system (CNS) and PNS. The extremes of this clinical-neurophysiological continuum were occupied by AIDP and CIDP on one limit and MS on the other. The intermediate part of the mentioned spectrum was occupied by a syndrome of combined central and peripheral inflammatory demyelination.

The study demonstrated that the subclinical impairment of the CNS in demyelinating polyneuropathies could be detected by means of electrophysiological and neuroimagery investigations. In cases of AIDP subclinical signs of pyramidal tract impairment were established based on conduction in the pyramidal pathway fibers by means of motor evoked potentials (MEP). The clinical impairment of the CNS was established within the motor-sensory phenotype of the CIDP. Clinical signs of pyramidal pathway impairment were found in 12,7% cases from the mentioned group. Significant number of patients had subclinical signs of CNS impairment: in 45% cases by means of MEP and in 41,2% cases – by means of MR imagery. The central motor conduction time was significantly increased in patients with demyelinating polyneuropathies. MRI modifications in CIDP were similar to those determined in MS.

The study revealed the peculiarities of the form of CIDP with CNS impairment: develops within the motor-sensory phenotype, mainly in females, in remitting-relapsing course of the disease, the degree of the motor and sensory deficit is more expressed, it is resistant to the administration of conventional immunosupressor treatment.

The study demonstrated that in a significant number of patients with MS – in 53,3% cases subclinical signs of peripheral nerve impairment occurred. The senzitive fibres of the sural and motor fibres of the peroneal nerves were more frequently involved.

In hereditary demyelinating neuropathies clinical and electrophysiological signs of CNS impairment were established rather less frequent. The CNS impairment could be established based on alteration of the genes that codify the protein both from the CNS and PNS myelin components as connexin 32.